Isolation of viruses from stools in stem cell transplant recipients: a prospective surveillance study

Abstract

Summary:We prospectively examined stool specimens for enteric viruses in 75 stem cell transplant recipients (autologous 48, allogeneic 27) to determine the frequency and significance of these infections. Only six patients (8%) had a positive isolate. Five of these were allograft recipients (18%) compared to one autograft recipient (2%) (P = 0.02). Unrelated donor BMT recipients were at the highest risk for a viral isolate (OR = 10.5). Adenovirus was the commonest isolate (four patients). One patient each had an echovirus, enterovirus and small round structured virus identified. No correlation was found between the severity of gastro-intestinal symptoms and detection of a viral pathogen. There was no correlation with GVHD or CMV status. The only risk factor identified for isolation of an enterovirus was allogeneic BMT from an unrelated donor. There was a negative correlation with PBSC grafts. All the patients infected with an enteric virus had concomitant infection with other pathogens, compared to only 18% of uninfected patients (P = 0.001). The non-relapse mortality of the infected patients was 50% and only 7% in the uninfected patients (P = 0.01, OR = 12.5), although the isolated virus was the direct cause of death in one patient only. This study indicates a low rate of enteric virus isolation in recipients of PBSC grafts, both autologous and allogeneic. However, unrelated donor BMT is associated with a higher risk of enteric virus infection and an adverse outcome. Bone Marrow Transplantation (2000) 25, 277-282.

Infections during mobilizing chemotherapy and following autologous stem cell transplantation

“…This is consistent with earlier reports. [18][19][20] In conclusion, this retrospective review showed no increase in infection risk following either one or two cycles of mobilizing chemotherapy prior to SCT. The extra weeks of neutropenia also did not alter the incidence of infection following SCT.…”

GI complications in pediatric patients post-BMT

“…The viruses found (rotavirus, adenovirus, astrovirus and CMV) are well recognized as causes of diarrhea in BMT patients. 14,17 The mean day of onset was day þ 25. This fairly late onset may simply represent prolonged hospitalization with iatrogenic exposure, other unknown confounders or merely a chance observation.…”

“…The majority of the published data regarding these complications comes from adult studies. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] A paucity of information exists in the published literature regarding the incidence, range and severity of gastrointestinal (GI) complications in pediatric patients in the immediate post-BMT period. 19,20 The majority of the pediatric studies examined specific complications such as veno-occlusive disease (VOD), acute pancreatitis or typhilitis in fairly homogeneous patient populations.…”

Enterovirus infections following T-cell depleted allogeneic transplants in adults

“…[8][9][10][11] The only patient who had enterovirus isolated from stool samples during a diarrhoeal episode had GVHD of the gut as well and the role of enterovirus in causing diarrhoea was not clear. 13 The more serious complications of enterovirus infections, such as CNS and cardiac involvement, were not documented in any of the patients. All the CSF, pericardial and pleural fluids obtained during this period were subjected to viral culture and RT-PCR, but no enteroviruses were detected.…”